On 24 September 2024, the Lung Cancer Care Continuum Policy Forum Series convened in Hong Kong, bringing together leading experts from the health system to assess the current state of lung cancer management, enhance collaboration across specialities, and formulate policy recommendations specific to Hong Kong.1 This inaugural event was the first in a series aimed at evaluating existing research and advancing local lung cancer care practices, with a particular emphasis on improving screening initiatives.

Despite the diversity of specialisations represented, the experts unanimously emphasised a shared goal of reducing lung cancer mortality and alleviating the overall burden of the disease. They highlighted the importance of collaboration, data sharing, and open dialogue for aligning efforts towards this common objective. Reflecting the group’s collective perspective, insights and contributions from the presentations and discussions have been consolidated into this editorial.

Lung cancer remains one of the most common and fatal cancers in Hong Kong; the 5978 new cases reported in 2021 constituted 15.5% of all cancer diagnoses.2 The age-standardised mortality rates for lung cancer were 29.7 and 14.0 per 100 000 standard population among men and women, respectively.2 Hong Kong’s current strategy mainly targets tobacco use as the primary cause of lung cancer but lacks a comprehensive framework for screening and treatment.

Tobacco control progress is evident in Hong Kong, where the smoking rate was substantially lower than the global average of 22.3%.3 Through sustained efforts, Hong Kong has achieved a steady decline in smoking rates, from 12.4% in 2000 to 9.1% in 2023.4 This progress is attributed to the enforcement of comprehensive smoking control measures, including taxation, implementation of pictorial health warnings, expansion of non-smoking areas, and prohibition of alternative smoking products. However, the unique epidemiology of lung cancer in the region, where the majority of cases occur in non-smokers, underscores the need for broader focus beyond smoking cessation.5

The experts identified several key challenges, including the absence of centralised guidelines, limited access to screening and precision diagnostics, and gaps in public awareness and healthcare integration. Currently, the Cancer Expert Working Group on Cancer Prevention and Screening of the Centre for Health Protection does not recommend routine screening for lung cancer among asymptomatic individuals with moderate risk.6 An important barrier remains the lack of a comprehensive lung cancer control plan, resulting in late-stage diagnoses and worse patient outcomes. Additionally, care is primarily managed by specialists, with minimal involvement from primary care physicians. The experts called for the establishment of a dedicated control plan focusing on prevention, screening, treatment, and enhanced care coordination to improve accessibility and outcomes.

Lung cancer screening is recognised as a critical intervention for early detection, particularly in high-risk populations. Authorities in the United Kingdom, Australia, Taiwan, the United States, China, Singapore, Canada, Korea, and Japan have recommended lung cancer screening for individuals aged 50 to 55 years, with cessation at 70 to 74 years.6 However, Hong Kong has yet to establish a government-funded, population-based screening programme targeting high-risk groups. The Chief Executive’s 2024 Policy Address highlighted the need to explore an artificial intelligence (AI)–assisted lung cancer screening programme.7 The experts strongly supported this initiative, citing the success of the colorectal cancer screening programme for high-risk individuals,8 which demonstrated the feasibility of translating clinical evidence into real-world practice through a multidisciplinary approach. This model could serve as a framework for developing an effective lung cancer screening programme in Hong Kong.

The economic implications of lung cancer care were also discussed. The experts emphasised the cost-effectiveness of low-dose computed tomography (LDCT) screening for high-risk smokers and non-smokers. Evidence was presented indicating that, over a lifetime, the incremental cost-effectiveness ratios of LDCT screening are well within the affordability range for Hong Kong’s healthcare expenditures, based on prior experiences with willingness-to-pay thresholds.9 10 Consequently, there is robust justification for the initiation of LDCT-based lung cancer screening among all high-risk individuals.11 This approach has the potential to greatly reduce the lung cancer burden and improve population-level outcomes. A report from regions that have adopted lung cancer screening, including Taiwan12—where the lung cancer epidemiology closely resembles that of Hong Kong—demonstrated a substantial shift towards earlier-stage diagnoses. The ability to detect lung cancer at an earlier stage, combined with timely and appropriate management, can lead to reduced mortality and improved treatment outcomes.

Innovative approaches to lung cancer screening were also presented. The ongoing LC-SHIELD study (Lung Cancer Screening in High-risk Non-smokers by Artificial Intelligence Device) utilises AI to screen high-risk non-smokers, a critical subpopulation considering that >50% of lung cancer cases in East Asia occur in non-smokers.13 The application of AI may enhance the sensitivity and specificity of screening, particularly for individuals with unique risk profiles, such as those with a family history of lung cancer or genetic predisposition. The experts noted the limitations of conventional tools (eg, chest X-rays), which lack the sensitivity of LDCT for detecting early-stage lung cancer.14 There was support for the adoption of innovative methods, including liquid biopsy and AI-enhanced LDCT interpretation, which improve early detection rates but reduce costs by minimising false positives and optimising the screening process. Such innovations offer promising opportunities to enhance lung cancer care in Hong Kong, making screening more efficient and accessible.

Lung cancer care in Hong Kong is primarily managed by tertiary care specialists, with limited integration across different levels of the healthcare system. The experts highlighted the success of a community-based charity programme designed to increase public awareness of lung cancer screening. This programme provided a single round of LDCT screening of the thorax to 99 asymptomatic adults with a family history of lung cancer and/or a history of smoking. Positive LDCT results were observed in 47 participants (47%), and lung cancer (all adenocarcinomas) was ultimately diagnosed in six participants (6%).12 This detection rate in Hong Kong appears higher than those reported in recent international trials of LDCT for lung cancer screening,15 16 17 indicating a need to revise eligibility criteria for greater emphasis on family history and to leverage local clinical expertise for lesion assessment. The findings from the programme were subsequently published in an international peer-reviewed medical journal and presented at the 2024 World Conference on Lung Cancer.18

The published results underscore the potential for adoption of similar programmes and highlight the benefits of incorporating LDCT screening into routine health checks for high-risk individuals. These findings strengthen the case for enhancing access to screening, supporting early detection efforts, and improving lung cancer outcomes in Hong Kong.

Although LDCT is a promising tool, its effectiveness depends on collaboration among multidisciplinary healthcare teams.19 The experts noted the challenge posed by incidental pulmonary nodules, which are frequently detected during LDCT screening but are often benign. These findings can increase patient anxiety and place additional strain on healthcare systems due to unnecessary invasive procedures.20 The experts also emphasised adherence to updated guidelines, such as those from the Fleischner Society, for appropriate management of incidental pulmonary nodules.21 Shared decision-making between patients and healthcare providers was considered essential to ensure that individuals understand the risks and benefits of screening.

The implementation of lung cancer screening presents challenges related to the psychosocial impact, particularly ‘scanxiety’—the anticipatory anxiety associated with screening preparation, procedures, and results.22 23 The experts highlighted the importance of incorporating psychological support into screening programmes to enhance patient participation and adherence, especially among younger individuals who may avoid screening due to fear.

Based on insights shared during the session, the experts formulated five key recommendations to address critical challenges in lung cancer screening and care in Hong Kong. These recommendations reflect collective expertise and propose a holistic approach to advancing early detection, improving healthcare integration, and enhancing accessibility and outcomes for patients.

1. Develop a comprehensive lung cancer control plan: Establish a detailed, government-funded plan covering the entire patient care continuum to standardise clinical practices throughout the health system.
2. Implement system-wide screening programmes: Introduce lung cancer screening initiatives targeting high-risk populations, such as smokers and individuals with genetic predisposition, ensuring that these programmes are accessible and tailored to local needs.
3. Improve healthcare integration: Strengthen collaboration between primary care providers and specialists to streamline the patient care continuum, particularly in the management of follow-up care for individuals with incidental findings.
4. Address psychosocial barriers: Incorporate psychological support and patient education into lung cancer screening and management programmes to reduce anxiety and improve participation.
5. Expand screening programmes using AI technology: Promote research and application of AI-enhanced LDCT screening programmes to enhance early detection and cost-effectiveness.

The first session of the Lung Cancer Care Continuum Policy Forum Series concluded with an emphasis on adopting a multipronged approach that involves research, policy advocacy, and patient education. During future sessions that more fully explore the patient care continuum for lung cancer care, the aim will be to achieve consensus regarding a unified strategy that aligns local clinical and policy efforts for lung cancer management. The outcomes of these discussions will play a central role in shaping the future of lung cancer care in Hong Kong, ensuring timely detection, equitable access to care, and improved survival outcomes for future generations.

All authors contributed to the concept or design, acquisition of data, analysis or interpretation of data, drafting of the manuscript, and critical revision of the manuscript for important intellectual content. All authors had full access to the data, contributed to the study, approved the final version for publication, and take responsibility for its accuracy and integrity.

ADL Sihoe has acted as a consultant for AstraZeneca, Medela, and Roche, while receiving support from Medtronic and Nestlé. MSC Li has received grants or contracts from AstraZeneca, Gilead, MSD, Takeda, and Johnson & Johnson. He has received honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from entities including AstraZeneca, Novartis, Amgen, Pfizer, Takeda, ACE Oncology, Gilead, Guardant Health, Janssen, Merck, MSD, and BMS. He has also received support for attending meetings and/or travel from AstraZeneca, Pfizer, Daiichi Sankyo, MSD, Roche, Janssen, and Amgen. Additionally, he has served on advisory boards for AstraZeneca, Pfizer, Takeda, Amgen, AnHeart Therapeutics, Yuhan, BlossomHill Therapeutics, and Janssen. MCS Wong is an honorary medical advisor of GenieBiome Ltd. He is an advisory committee member of Pfizer; an external expert of GlaxoSmithKline; a member of the advisory board of AstraZeneca and has been paid consultancy fees for providing advice on research. Other authors declared no conflicts of interest.

This editorial was funded by Roche Diagnostics and MSD. The funders had no involvement in the design of the Forum Series, data collection, analysis, interpretation, or manuscript preparation.

1. Asia Pacific Policy Review and Engagement for Lung Cancer. First edition of the Lung Cancer Care Continuum Policy Forum Series: Early Detection in Hong Kong. Available from: https://aspirelungcancer.com/news/lung-cancer-care-continuum-policy-forum. Accessed 7 Feb 2025.

2. Centre for Health Protection, Department of Health, Hong Kong SAR Government. Lung cancer. 2024 Jan 12. Available from: https://www.chp.gov.hk/en/healthtopics/content/25/49.html. Accessed 11 Oct 2024.

3. World Health Organization. Tobacco. 2023 Jul 31. Available from: https://www.who.int/news-room/fact-sheets/detail/tobacco. Accessed 14 Oct 2024.

4. Census and Statistics Department, Hong Kong SAR Government. Thematic Household Survey Report–Report No. 79–Pattern of Smoking. 2nd Issue 2024. Available from: https://www.censtatd.gov.hk/en/wbr.html?ecode=B11302012024XX01&scode=380. Accessed 14 Oct 2024.

5. Noronha V, Budukh A, Chaturvedi P, et al. Uniqueness of lung cancer in Southeast Asia. Lancet Reg Health Southeast Asia 2024;27:100430. Crossref

6. Non-communicable Disease Branch, Centre for Health Protection, Department of Health, Hong Kong SAR Government. Lung cancer prevention and screening. June 2023. Available from: https://www.chp.gov.hk/files/pdf/6_lung_cancer_prevention_and_screening_eng.pdf. Accessed 11 Feb 2025.

7. Hong Kong SAR Government. The Chief Executive’s 2024 Policy Address. Oct 2024. Available from: https://www.policyaddress.gov.hk/2024/en/. Accessed 1 Nov 2024.

8. Department of Health, Hong Kong SAR Government. Colorectal Cancer Screening Programme. Available from: https://www.colonscreen.gov.hk/en/public/index.html. Accessed 11 Feb 2025.

9. Loong H, Pan X, Chiu CH, et al. P1.17-03 Cost-effectiveness of low-dose computerized tomography lung cancer screening in high-risk non-smokers and smokers in Hong Kong. J Thorac Oncol 2023;18 Suppl:S223. Crossref

10. Census and Statistics Department, Hong Kong SAR Government. Table 310-31001: Gross Domestic Product (GDP), implicit price deflator of GDP and per capita GDP. 2024 Nov 15. Available from: https://www.censtatd.gov.hk/en/web_table.html?id=310-31001. Accessed 12 Feb 2025.

11. Loong HH, Pan X, Chiu CH, et al. 486P–Fiscal feasibility and implications of integrating lung cancer screening into Hong Kong’s healthcare system [poster]. 2023 Dec 2. Available from: https://oncologypro.esmo.org/meeting-resources/esmo-asia-congress-2023/fiscal-feasibility-and-implications-of-integrating-lung-cancer-screening-into-hong-kong-s-healthcare-system. Accessed 1 Nov 2024.

12. Yang PC, Chen TH, Huang KP, Lin LJ, Wu CC. Taiwan national lung cancer early detection program for heavy smokers and non-smokers with family history of lung cancer [abstract]. J Clin Oncol 2024;42;16_suppl:8009. Crossref

13. Zhou F, Zhou C. Lung cancer in never smokers—the East Asian experience. Transl Lung Cancer Res 2018;7:450-63. Crossref

14. Amicizia D, Piazza MF, Marchini F, et al. Systematic review of lung cancer screening: advancements and strategies for implementation. Healthcare (Basel) 2023;11:2085. Crossref

15. National Lung Screening Trial Research Team; Aberle DR, Adams AM, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 2011;365:395-409. Crossref

16. Yang P. PS01.02 National lung cancer screening program in Taiwan: the TALENT Study. J Thorac Oncol 2021;16:S58. Crossref

17. de Koning HJ, van der Aalst CM, de Jong PA, et al. Reduced lung-cancer mortality with volume CT screening in a randomized trial. N Engl J Med 2020;382:503-13. Crossref

18. Sihoe AD, Fong NK, Yam AS, Cheng MM, Yau DL, Ng AW. Real-world first round results from a charity lung cancer screening program in East Asia. J Thorac Dis 2024;16:5890-8. Crossref

19. Ramaswamy A. Lung cancer screening: review and 2021 update. Curr Pulmonol Rep 2022;11:15-28. Crossref

20. Lin Y, Khurelsukh K, Li IG, et al. Incidental findings in lung cancer screening. Cancers 2024;16:2600. Crossref

21. Lam DC, Liam CK, Andarini S, et al. Lung cancer screening in Asia: an expert consensus report. J Thorac Oncol 2023;18:1303-22. Crossref

22. Feiler B. Scanxiety. Fear of a postcancer ritual. Time 2011;177:56.

23. Goodwin B, Anderson L, Collins K, et al. Anticipatory anxiety and participation in cancer screening. A systematic review. Psychooncology 2023;32:1773-86. Crossref

Civil liability of doctors arises when there is a clinically negligent act or omission resulting in harm as a consequence of a doctor not meeting the standard of care as expected from reasonable medical practice or failure to warn.1 Do clinical errors and mistakes necessarily equate to negligence? The essential elements required to establish negligence, are: (1) the existence of a duty of care owed to the patient; (2) a breach of duty as determined by standard of care; (3) the patient has experienced harm; and (4) a causal connection, between the defendant’s careless act and the resulting damage incurred with the damage considered foreseeable and not too remote.2 In Hatcher v Black,3 Lord Denning explained a case that a woman P, who suffered side-effects from an operation on her throat and sued the surgeon concerned. Denning J stated that:
“…on the road or in a factory there ought not to be any accidents if everyone used proper care, but in a hospital there was always a risk. It would be disastrous to the community if a doctor examining a patient or operating at the table, instead of getting on with his work, were forever looking over his shoulder to see if someone was coming up with a dagger. The jury should not find the defendant negligent simply because one of the risks inherent in an operation actually took place, or because in a matter of opinion he made an error of judgement. They should find him liable only if he had fallen short of the standard of medical care, so that he was deserving of censure…”
(The jury found in favour of the defendant).

According to the Bolam test,4 “a doctor will not be found negligent if he/she has acted in accordance with a practice accepted as proper by a reasonable body of medical opinion”. It appears unreasonable or of limited social value to impose a criminal sanction on a medical practitioner for genuine clinical errors and mistakes.

The majority of litigation, following alleged medical malpractice, is brought under the tort of negligence (civil claims) and the remedy sought is monetary compensation. Criminalisation of medical malpractice falls into the realm of retributive justice which is a system of criminal justice focusing solely on punishment, rather than deterrence or the rehabilitation of offenders. The punishment should be in proportion to the seriousness of the crime committed.5 The negligent act should be culpable to constitute a criminal act, such as gross negligence manslaughter (GNM).6 This raises pertinent issues and questions in health care, such as: Is criminal prosecution really promoting patient safety and safeguarding public interest? Should the focus be on conduct rather than outcome? Should the use of restorative justice, emphasising retribution, surpass deterrence and rehabilitation?7

An expert panel conducted a pre-recorded seminar, followed by an interactive panel, to analyse GNM, in the healthcare setting, across different common law jurisdictions (including Australia, England, Hong Kong, Singapore and the United States) in November 2021.8 A paper is under preparation which reports the critical points of those presentations, together with further analyses of cases and literature in jurisdictions adopting common law, to provide a better understanding of how clinical negligence might lead to criminal proceedings. This editorial aims to recap the English case of Bawa-Garba,9 to discuss the factors to be taken into consideration for medical crime. There were a number of high-profile criminal investigations and prosecutions of healthcare professionals (HCPs) in England, with no offence recorded in Scotland and only 14 HCPs being charged with offences of criminal negligence in Canada and just over 30 GNM prosecutions since 1830 in England.7

In the Garba case,9 the jury found the defendant paediatrician’s conduct to be “truly exceptionally bad” (meaning it was far below the standard of care expected by a competent paediatrician and that it amounted to the criminal offence of GNM). The literature has raised criticisms of the findings for failing to give due consideration to organisational factors, such as system failure or lack of permanent supporting staff.6 10 The Box summarises the negligence of the defendant doctor and factors contributing to her negligence.

The investigations and prosecutions regarding Garba were perceived as arbitrary and inconsistent.11 This resulted in a rapid policy review, as described in Gross Negligence Manslaughter in Healthcare in 2018.12 The panel was clear that HCPs could not be, or be seen to be, above the law and should be held to account where necessary. It was equally evident that HCPs are working in the complexity of a modern healthcare system, under a stressful environment and this should also be taken into consideration when deciding whether to pursue a GNM investigation. Doctors who have made an erroneous or suboptimal decision, without the intent to harm, acted in a manner that arguably does not rise to the level of criminal blameworthiness.13

A negligent doctor should not be held criminally liable for a brief lapse of concentration or an inadvertent error of judgement and it has been argued that three factors: (1) awareness; (2) choice (choose to run the risk); and (3) control (has the opportunity to act differently) should be present for the establishment of the negligent conduct to be considered culpable within the criminal context.13 An error is trying to do the right thing but performing same wrongly which does not reflect an intentional deviation from accepted practices.14

Would Garba9 be ruled differently, with consideration of culpability and violation of the three factors of awareness, choice and control? Dr Bawa-Garba’s fitness to practise had been found to be impaired causing her suspension from practising for 1 year by the tribunal. The General Medical Council appealed, on the ground that the tribunal should have ordered her to be erased from the register and substituted the sanction of erasure for that of suspension.15 The ruling led to a backlash from doctors who believed that she should not have been singled out for punishment because of the multiple system failures which led to the boy’s death. Dr Bawa-Garba finally won an appeal against being struck off, restoring the 1-year suspension.16 The judgement states that the task of the tribunal was to decide what sanction would “most appropriately meet the overriding objective of protecting the public.”16 Taking into account the particular circumstances of this case and the aggravating and mitigating factors, the Court of Appeal felt that erasure was not necessary to meet the objectives of: protecting the public; maintaining public confidence; and promoting and upholding proper professional standards. The Court considered that the expert tribunal was entitled to form the view that a suspension order could meet these statutory objectives.

Dr Bawa-Garba is now back at work and has finished her specialist training.17 The main lessons learned are: to analyse all circumstances; to assess whether the negligent act is truly exceptionally bad; and whether there were extenuating circumstances that need to be taken into account.

Concept or design: All authors.
Acquisition of data: All authors.
Analysis or interpretation of data: All authors.
Drafting of the manuscript: A Lee, T Cheung.
Critical revision of the manuscript for important intellectual content: All authors.

All authors had full access to the data, contributed to the study, approved the final version for publication, and take responsibility for its accuracy and integrity.

All authors have disclosed no conflicts of interest.

This editorial has been presented in the Gross Negligence Manslaughter Seminar and Panel Discussion: Reflection from different Jurisdictions adopting Common Law organised by the Centre for Health Education and Health Promotion of The Chinese University of Hong Kong and co-organised by the Centre for Medical Ethics and Law of The University of Hong Kong, New Medico-Legal Society of Hong Kong, American College of Legal Medicine, the Australasian College of Legal Medicine, and the Healthcare Division of Allied World Assurance Company held in November 2021.

This editorial received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

The opinions expressed reflect the views of the authors not the institutions to which they are affiliated.

1. Lee A. Clinical liability in Hong Kong: revisiting duty and standard of care. In: Raposo VL, Beran RG, editors. Medical Liability in Asia and Australasia. Ius Gentium: Comparative Perspectives on Law and Justice, vol 94. Singapore: Springer; 2022. Crossref

2. Jones M, Dugdale AM, Simpson M. Clerk & Lindsell on Torts. 23rd Edition, London: Sweet & Maxwell; 2020.

3. Bolam v Friern Hospital Management Committee. 1 WLR 582; 1957.

4. Hatcher v Black. The Times. 2 July 1954.

5. Meyer JF. Retributive Justice. Encyclopedia Britannica, 12 Sep 2014. Available from: https://www.britannica.com/topic/retributive-justice. Accessed 6 Jan 2024.

6. Lee A. Key elements of gross negligence manslaughter in the clinical setting. Hong Kong Med J 2023;29:99-101. Crossref

7. Farrell AM, Alghrani A, Kazarian M. Gross negligence manslaughter in healthcare: time for a restorative justice approach? Med Law Rev 2020;28:526-48. Crossref

8. Anawis M, Beran RG, Cheung T, Ho C, Kim H, Lee A. Gross Negligence Manslaughter Seminar and Panel Discussion: Reflection from different Jurisdictions adopting Common Law. November 2021. Available from: https://www.chep.cuhk.edu.hk/GNM/. Accessed 15 Jan 2024.

9. R v Hadiza Bawa-Garba. EWCA Crim 1841; 2016.

10. Cohen D. Back to blame: the Bawa-Garba case and the patient safety agenda. BMJ 2017;359:j5534. Crossref

11. Lee DW, Tong KW. What constitutes negligence and gross negligence manslaughter? In Chiu JS, Lee A, Tong KW, editors. Healthcare Law and Ethics: Principles and Practices. Hong Kong: City University of Hong Kong Press; 2023.

12. Department of Health and Social Care of the United Kingdom. Gross Negligence Manslaughter in Healthcare. The Report of a Rapid Policy Review. June 2018. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/717946/Williams_Report.pdf. Accessed 25 Jan 2025.

13. Robson M, Maskill J, Brookbanks W. Doctors are aggrieved—should they be? Gross negligence manslaughter and the culpable doctor. J Crim Law 2020;84:312-40. Crossref

14. Merry A, Brookbanks W. Violations. In: Merry and McCall Smith’s Errors, Medicine and the Law. 2nd Edition. Cambridge: Cambridge University Press; 2017: 141-82. Crossref

15. GMC v Dr Bawa-Garba. EWHC 76 (Admin); 2018.

16. Hadiza Bawa-Garba v GMC. EWCA Civ 18979; 2018.

17. Dyer C. Hadiza Bawa-Garba can return to practice under close supervision. BMJ 2019;365:l1702. Crossref

By the late 20th century, traditional teaching methods in postgraduate medical education were considered inadequate for preparing doctors to navigate modern healthcare systems, thereby posing risks to patient safety. This realisation led to a global shift towards competency-based medical education.1 2 3 The Hong Kong Academy of Medicine (HKAM) identifies seven key competencies essential for contemporary medical practitioners, namely, professional expertise, interpersonal communication, teamwork, leadership, professionalism, academia, and health promotion. The achievement of proficiency in these areas requires novel approaches to teaching and learning.

Traditional postgraduate medical education is often centred around two main principles: the transmission of knowledge and the ‘see one, do one, teach one’ model. Although knowledge acquisition is essential, mere memorisation of facts and information does not lead to excellence in medical practice. Effective education requires more than the delivery of information. It involves selecting content aligned with learning objectives, organising and presenting material in ways that reflect how people learn, and fostering motivation to engage with the material.4 It had been demonstrated that knowledge acquisition alone does not result in expertise.5 Individuals may successfully recall information and perform well on examinations, but they often encounter difficulties when addressing real-life clinical problems. The application of knowledge is critical, and hands-on clinical experience is invaluable. However, the tasks encountered in postgraduate medicine are more complex and challenging than those in traditional apprenticeships, rendering the ‘see one, do one, teach one’ method insufficient. Teaching methods that provide support and promote a deeper understanding of material are necessary to develop true expertise in medicine.6 The importance of such teaching methods underscores the critical need for faculty development—commonly referred to as training for trainers—which involves acquiring new skills and knowledge while undergoing a shift in mindset.

Faculty development is central to the successful implementation of competency-based medical education. It includes activities undertaken by healthcare professionals to enhance teaching, leadership, research, and scholarly abilities in both individual and group contexts.7 This emphasis on faculty development was highlighted in the Position Paper on Postgraduate Medical Education, published in 2023.8 The Hong Kong Jockey Club Innovative Learning Centre for Medicine (ILCM), established by HKAM, was created to modernise postgraduate medical education in Hong Kong. Initially focused on simulation-based medical education, the ILCM has since broadened its scope to address all aspects of postgraduate medical education.9 Recognising the importance of faculty development, the ILCM has assumed a leading role in advocating for this concept within the medical community. To advance these efforts, the ILCM formed the Faculty Development Workgroup (the ‘Workgroup’), which includes representatives from all 15 Colleges under HKAM, to collaborate on faculty development initiatives.

To ensure that faculty development in postgraduate medical education is competency-based, the Workgroup conducted a literature review to identify existing frameworks and identified seven relevant models.10 11 12 13 14 15 16 After careful deliberation, the frameworks proposed by Hesketh et al12 and the Academy of Medical Educators16 were deemed the most comprehensive and appropriate for adaptation to the local context in Hong Kong.

Steinert7 defines faculty as all individuals involved in teaching and educating learners across the educational continuum (eg, undergraduate, graduate, postgraduate, and continuing professional development), leadership and management within universities, hospitals, and the community, as well as research and scholarship in the health professions (eg, communication sciences, dentistry, nursing, and rehabilitation sciences). Based on this definition, the Workgroup delineated four categories of faculty within the framework: trainers, examiners, supervisors of training, and collegial leads in medical education within each College of HKAM. The initial phase of development focused on creating the Framework for Faculty Development of Trainers, which outlines the key competencies required for trainers. This framework facilitates the identification of individual learning needs, supports effective delivery of course content, and guides the evaluation of outcomes of the faculty development programme.17

The Workgroup adopted the three-circle model to classify learning outcomes proposed by Simpson et al.18 This model categorises competencies into core tasks, approaches to tasks, and professional identity, ensuring that trainers perform their roles effectively while approaching these roles with appropriate attitudes and professionalism (Fig).18

The Framework for Faculty Development of Trainers17 was approved earlier this year by the Education Committee and the Council of HKAM (Fig). In the future, the ILCM will design and implement training workshops guided by the following principles19:

Evidence-informed educational design

Relevant content

Experiential learning with opportunities for practice and application

Opportunities for feedback and reflection

Intentional community building

Moreover, a recent systematic review has highlighted key principles for effective faculty development that extend beyond workshops and individual teaching effectiveness. These principles include strengthening participants’ identities as educators, promoting recognition of educational excellence and leadership development, and fostering communities of practice to support ongoing learning and skill refinement.20 This comprehensive approach reflects the learning process for clinical skills, which requires practice, feedback, and continuous development in the workplace. Therefore, effective faculty development will require sustained support from HKAM and collaboration with stakeholders across all Colleges to ensure that faculty continue to advance their skills after completing workshops.

Faculty development is essential for the advancement of postgraduate medical education in Hong Kong. By equipping trainers with the appropriate competencies and skills, the framework ensures that doctors in training receive high-quality education and mentorship, ultimately enhancing patient care and outcomes within the healthcare system.6

All authors have contributed equally to the concept, development and critical revision of the manuscript. All authors had full access to the data, contributed to the study, approved the final version for publication, and take responsibility for its accuracy and integrity.

All authors have declared no conflicts of interest.

This editorial received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

1. Kohn LT, Corrigan JM, Donaldson MS, editors. To Err Is Human: Building a Safer Health System. Washington (DC): National Academies Press; 2000.

2. Institute of Medicine (US) Committee on Quality of Health Care in America. Crossing the quality chasm: a new health system for the 21st century. Washington (DC): National Academies Press (US); 2001.

3. Whitehead CR, Austin Z, Hodges BD. Flower power: the armoured expert in the CanMEDS competency framework? Adv Health Sci Educ Theory Pract 2011;16:681-94. Crossref

4. Swanwick T, Forrest K, O’Brien BC, editors. Understanding Medical Education: Evidence, Theory, and Practice. The Association for the Study of Medical Education (ASME); 2019. Crossref

5. Dreyfus SE, Dreyfus HL. A five-stage model of the mental activities involved in direct skill acquisition. Operations Research Center, University of California, Berkeley; 1980.

6. So HY. Postgraduate medical education: see one, do one, teach one…and what else? Hong Kong Med J 2023;29:104. Crossref

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9. Chen PP, So HY, Lo JS, Cheng BC. Modernising postgraduate medical education: evolving roles of the Hong Kong Jockey Club Innovative Learning Centre for Medicine in the Hong Kong Academy of Medicine. Hong Kong Med J 2023;29:480-3. Crossref

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11. Harden RM, Crosby J. AMEE Guide No. 20: The good teacher is more than a lecturer—the twelve roles of the teacher. Med Teach 2000;22:334-47. Crossref

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13. Molenaar WM, Zanting A, van Beukelen P, et al. A framework of teaching competencies across the medical education continuum. Med Teach 2009;31:390-6. Crossref

14. Milner RJ, Gusic ME, Thorndyke LE. Perspective: toward a competency framework for faculty. Acad Med 2011;86:1204-10. Crossref

15. Srinivasan M, Li ST, Meyers FJ, et al. “Teaching as a Competency”: competencies for medical educators. Acad Med 2011;86:1211-20. Crossref

16. Academy of Medical Educators. Professional standards for medical, dental and veterinary educators (fourth edition). 2022. Available from: https://www.medicaleducators.org/write/MediaManager/Documents/AoME_Professional_Standards_4th_edition_1.0_(web_full_single_page_spreads).pdf. Accessed 1 Nov 2024.

17. Hong Kong Academy of Medicine. Framework for Faculty Development Part 1: Trainers. September 2024. Available from: https://www.hkam.org.hk/sites/default/files/PDFs/2024/HKAM_Faculty%20Development%20Framework_Part%201.pdf?v=1729586789500. Accessed 20 Sep 2024.

18. Simpson JG, Furnace J, Crosby J, et al. The Scottish doctor—learning outcomes for the medical undergraduate in Scotland: a foundation for competent and reflective practitioners. Med Teach 2002;24:136-43. Crossref

19. Steinert Y, Mann K, Centeno A, et al. A systematic review of faculty development initiatives designed to improve teaching effectiveness in medical education: BEME Guide No. 8. Med Teach 2006;28:497-526. Crossref

20. Steinert Y, Mann K, Anderson B, et al. A systematic review of faculty development initiatives designed to enhance teaching effectiveness: a 10-year update: BEME Guide No. 40. Med Teach 2016;38:769-86. Crossref

Women’s health differs from men’s health not only in biological and gender-specific aspects but also in societal and psychological dimensions, making it a crucial component of public health. The health of women and girls is particularly important because they often face disadvantages and vulnerabilities due to discrimination in many societies. In recent years, increased awareness of gender-specific health issues has underscored the need for comprehensive strategies to address women’s health concerns, including reproductive health, cancer prevention, and care for elderly women. This editorial provides an overview of the unique health challenges faced by women in Hong Kong throughout various stages of life and examines interventions designed to improve health outcomes for women.

Reproductive health is fundamental to women’s overall well-being, encompassing all aspects of the reproductive system and its functions.1 Health issues may arise at any stage of life, from menarche (the onset of the first menstrual period) to menopause. Multiple pregnancies, defined as the simultaneous presence of more than one fetus (eg, twins, triplets, or higher-order multiples), involve serious health risks.2 3 The perinatal mortality risk can be up to 7 times higher in twin pregnancies than in singleton pregnancies; risks increase further in triplet and quadruplet pregnancies.2 Since the introduction of assisted reproductive technology in 1978, the prevalence of multiple pregnancies has risen worldwide.2 A retrospective study analysing medical records from a university tertiary obstetric unit in Hong Kong showed that the prevalence of multiple pregnancies increased from 1.41% in the first decade (2000-2010) to 1.91% in the second decade (2010-2019).2 Despite this increase, the total mortality rate for multiple births significantly decreased, from 25.32 per 1000 births to 13.82 per 1000 births. This improvement has been attributed to advancements in antenatal care, enhanced treatment options, and reductions in preterm births.2 These findings highlight the importance of continued research and targeted interventions in reproductive health to achieve better outcomes for women and infants.

Additionally, postpartum haemorrhage (PPH), a life-threatening condition characterised by excessive bleeding, is significantly more common in women with multiple pregnancies than in those with singleton pregnancies.4 A retrospective cohort study revealed a substantially elevated risk of severe PPH among women with twin pregnancies, particularly those who were obese, had conceived via in vitro fertilisation, or presented with placenta previa.4 Special attention must be given to pregnant women with these risk factors, including proactive preparations for the management of severe PPH to mitigate the risk of mortality. Enhanced monitoring and targeted interventions are essential for efforts to improve outcomes in this vulnerable population. Psychological morbidity is also frequently observed in pregnant women, particularly those experiencing threatened miscarriage.5 In a cross-sectional study of women in their first trimester, 48.4% to 76.7% reported distress.5 Notably, women with a history of miscarriage exhibited higher stress scores relative to those without such a history.5 6 Thus, early identification of women requiring additional psychological support, facilitated through psychometric instruments, is critical for improvements to maternal psychological well-being, which is also associated with better fetal outcomes.5

Moreover, pregnant women tend to be more vulnerable to communicable diseases such as coronavirus disease 2019 (COVID-19), more concerned about severe complications, and more fearful of vertical transmission to neonates; these tendencies impose additional psychological stress.7 8 According to a cross-sectional survey conducted in Hong Kong from 28 July 2020 to 13 August 2020, 83.1% of pregnant women expressed substantial concern about contracting COVID-19 during pregnancy, 70.5% feared intrauterine viral infection of their fetuses due to maternal COVID-19, and 84.3% opposed the ban on husbands accompanying their wives during labour and delivery.7 Governments and healthcare professionals should enhance public education to increase awareness of COVID-19—related complications during pregnancy, enabling women to approach the situation with informed perspectives and reducing unnecessary stress.7 The provision of universal screening for pregnant women, a widely supported approach, represents another intervention to alleviate the burden of disease.7

In addition to health concerns during pregnancy, infertility remains a major reproductive health issue for women, affecting nearly one in six adult women worldwide.9 Although advancements in fertility preservation technologies have enabled many patients to conceive their own biological children, some individuals have been unable to undergo the ovarian stimulation required for oocyte or embryo freezing, including prepubertal girls who are ineligible for the procedure.10 Ovarian tissue cryopreservation serves as an ideal option for preserving fertility in these cases.11 An in vivo study of nude mice demonstrated that grafted ovarian tissues remained viable after ovarian tissue cryopreservation and subsequent transplantation, supporting the implementation of this approach in Hong Kong.11

Cancer is a leading cause of death among women, and breast cancer is the most prevalent type in Hong Kong.12 13 Early detection through risk-based screening programmes is essential for reducing breast cancer–related morbidity and mortality.14 15 In Hong Kong, the Cancer Expert Working Group on Cancer Prevention and Screening has reviewed and updated its breast cancer screening recommendations, introducing slight changes for women at moderate risk.12 Women aged 44 to 69 years with increased breast cancer risk (eg, family history, benign breast disease, reproductive history, early menarche, high body mass index, and physical inactivity) are advised to consider biennial mammography screening after consulting their physicians.12

Advanced treatment plays an equally important role in managing breast cancer.16 Neoadjuvant chemotherapy (NAC), administered before definitive breast cancer surgery, reduces tumour size and facilitates surgery for patients.17 Insights from a 12-year review of the Hong Kong Breast Cancer Registry demonstrated the effectiveness of NAC, supporting its application in patients with stage II or higher disease, as well as those with human epidermal growth factor receptor 2–positive (non-luminal) or triple-negative breast cancers.16 The use of NAC in Hong Kong nearly doubled during the 12-year period, increasing from 5.6% in 2006-2011 to 10.3% in 2012-2017.16

Early prevention of cancer through human papillomavirus (HPV) vaccination plays an indispensable role in women’s health. Human papillomavirus vaccination is a safe and effective method for preventing cervical cancer, as well as other HPV-related cancers, including cancers of the anus, vulva, vagina, penis, and oropharynx.18 To improve vaccine coverage, the promotion of a gender-neutral vaccination programme within the school-based childhood immunisation framework is essential. A cross-sectional online survey in Hong Kong revealed that only 12.5% (63/503) of parents had consented to vaccination for their daughters.18 Parental misconceptions regarding vaccine safety and the ideal vaccination age represent major barriers that must be addressed to increase HPV vaccination coverage among children.18

As women age, they encounter unique health challenges, including an increased risk of osteoporosis, cardiovascular disease, and cognitive decline. Pelvic organ prolapse (POP) is a common health issue, reported by nearly 10% of the Chinese population.19 Increasing evidence supports surgical treatment over vaginal pessaries as a definitive intervention for POP. A recent multicentre retrospective study showed that POP surgeries were safe and effective for women aged ≥75 years in Hong Kong.20 Additionally, there is a need to emphasise the importance of the Hong Kong Reference Frameworks in managing chronic diseases among elderly women.21 These frameworks provide evidence-based, standardised guidelines for primary healthcare professionals to assist patients in preventing and managing conditions such as diabetes mellitus, hypertension, and common musculoskeletal disorders.21

In summary, the growing recognition of women’s health as a critical component of public health requires a comprehensive, evidence-based approach to implementing effective interventions that address the unique challenges faced by women at various life stages. This editorial has outlined prevalent health issues among women in Hong Kong and worldwide, emphasising the need for a multidimensional framework that integrates prevention, early detection, and effective treatment. Such an approach is essential to improve women’s health outcomes in the future.

All authors had full access to the data, contributed to the study, approved the final version for publication, and take responsibility for its accuracy and integrity.

All authors have disclosed no conflicts of interest.

The authors acknowledge the literature search and review assistance of Mr Zehuan Yang, Research Assistant at the Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong.

1. Global Perspectives on Women’s Sexual and Reproductive Health Across the Lifecourse. Cambridge International Law Journal; 2018.

2. Lau SL, Wong ST, Tse WT, et al. Perinatal mortality rate in multiple pregnancies: a 20-year retrospective study from a tertiary obstetric unit in Hong Kong. Hong Kong Med J 2022;28:347-56. Crossref

3. Sherer DM. Adverse perinatal outcome of twin pregnancies according to chorionicity: review of the literature. Am J Perinatol 2001;18:23-37. Crossref

4. Kong CW, To WW. Risk factors for postpartum haemorrhage in twin pregnancies and haemorrhage severity. Hong Kong Med J 2023;29:295-300. Crossref

5. Ip PN, Ng K, Wan OY, Kwok JW, Chung JP, Chan SS. Cross-sectional study to assess the psychological morbidity of women facing possible miscarriage. Hong Kong Med J 2023;29:498-505. Crossref

6. Farren J, Jalmbrant M, Ameye L, et al. Post-traumatic stress, anxiety and depression following miscarriage or ectopic pregnancy: a prospective cohort study. BMJ Open 2016;6:e011864. Crossref

7. Lok WY, Chow CY, Kong CW, To WW. Knowledge, attitudes, and behaviours of pregnant women towards COVID-19: a cross-sectional survey. Hong Kong Med J 2022;28:124-32. Crossref

8. Dashraath P, Wong JL, Lim MX, et al. Coronavirus disease 2019 (COVID-19) pandemic and pregnancy. Am J Obstet Gynecol 2020;222:521-31. Crossref

9. World Health Organization. 1 in 6 people globally affected by infertility: WHO. Last modified April 4, 2023. Available from: https://www.who.int/news/item/04-04-2023-1-in-6-people-globally-affected-by-infertility. Accessed 12 Dec 2024.

10. Dolmans MM, Donnez J. Fertility preservation in women for medical and social reasons: oocytes vs ovarian tissue. Best Pract Res Clin Obstet Gynaecol 2021;70:63-80. Crossref

11. Chung JP, Chan DY, Song Y, et al. Implementation of ovarian tissue cryopreservation in Hong Kong. Hong Kong Med J 2023;29:121-31. Crossref

12. Tsang TH, Wong KH, Allen K, et al. Update on the Recommendations on Breast Cancer Screening by the Cancer Expert Working Group on Cancer Prevention and Screening. Hong Kong Med J 2022;28:161-8. Crossref

13. Huang J, Chan PS, Lok V, et al. Global incidence and mortality of breast cancer: a trend analysis. Aging (Albany NY) 2021;13:5748-803. Crossref

14. Duffy S, Vulkan D, Cuckle H, et al. Annual mammographic screening to reduce breast cancer mortality in women from age 40 years: long-term follow-up of the UK Age RCT. Health Technol Assess 2020;24:1-24. Crossref

15. Henderson JT, Webber EM, Weyrich MS, et al. Screening for breast cancer: evidence report and systematic review for the US Preventive Services Task Force. JAMA 2024;331:1931-46. Crossref

16. Chan YH, Kwok CC, Tse DM, Lee HM, Tam PY, Cheung PS. Preoperative considerations and benefits of neoadjuvant chemotherapy: insights from a 12-year review of the Hong Kong Breast Cancer Registry. Hong Kong Med J 2023;29:198-207. Crossref

17. Shien T, Iwata H. Adjuvant and neoadjuvant therapy for breast cancer. Jpn J Clin Oncol 2020;50:225-9. Crossref

18. Lam EW, Ngan HY, Kun KY, Li DF, Wan WY, Chan PK. Awareness, perceptions, and acceptance of human papillomavirus vaccination among parents in Hong Kong. Hong Kong Med J 2023;29:287-94. Crossref

19. Pang H, Zhang L, Han S, et al. A nationwide population-based survey on the prevalence and risk factors of symptomatic pelvic organ prolapse in adult women in China—a pelvic organ prolapse quantification system-based study. BJOG 2021;128:1313-23. Crossref

20. Wong D, Lee YT, Tang GP, Chan SS. Surgical treatment of pelvic organ prolapse in women aged ≥75 years in Hong Kong: a multicentre retrospective study. Hong Kong Med J 2022;28:107-15. Crossref

21. Health Bureau, Primary Healthcare Commission. Reference Frameworks. Available from: https://www.healthbureau.gov.hk/phcc/main/frameworks.html?lang=2. Accessed 24 Nov 2024.

Healthcare for vulnerable populations, including but not limited to children, women (particularly during pregnancy), older adults, individuals with underlying long-term conditions, and those facing structural barriers associated with lower socio-economic status, remains one of the most formidable challenges in health protection and promotion worldwide. The advent of coronavirus disease 2019 (COVID-19) has exacerbated the vulnerability of these groups, placing them at greater risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and worse health outcomes.1 Global data indicate that COVID-19 has disproportionately affected these vulnerable groups, driven by a complex interplay of biological factors, social determinants, and overstretched healthcare services.2

A substantial body of evidence demonstrates the harmful and long-lasting consequences of COVID-19 on the development of children and adolescents, encompassing physical health, mental well-being, academic performance, and socio-emotional skills, both directly and indirectly.3 A recent review of the literature revealed that adolescents, children from ethnic minority backgrounds or lower-income families, and those with obesity were more susceptible to SARS-CoV-2 infection.4 While COVID-19 generally presents as a milder or moderate illness in children compared to adults, due to fundamental differences in immune responses, continued surveillance—such as wastewater monitoring and universal or pooled testing—remains critical to managing the spread of infection within communities.4 Serious conditions, although fortunately rare, require preparedness and response efforts from frontline paediatricians and intensivists to provide optimal respiratory support. A framework for airway management procedures has been proposed, based on a comprehensive system incorporating respiratory pattern monitoring, spontaneous respiration oxygenation, apnoeic oxygenation, manual ventilation, and scavenging to reduce the risk of healthcare-associated transmission.5 Case reports have described adolescent patients presenting with rare conditions, such as laboratory-confirmed SARS-CoV-2 infection with chilblain-like lesions6 and paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 after recovery from COVID-19.7 Both cases suggest that paediatricians should remain vigilant for potential symptoms and signs to enable timely diagnosis and mitigate transmission risks.

Although vaccination has proven effective in reducing the severity of COVID-19 and providing protection against post—COVID-19 conditions, increasing concerns persist regarding the knowledge gap on long-term efficacy and potential adverse events associated with COVID-19 vaccines.4 8 Gut microbiota may play an important role in the immune response to vaccination, offering a promising avenue for management of vaccine-related adverse effects. A pilot study in Hong Kong demonstrated the safety and tolerability of a microbiota-derived health supplement among children aged 5 to 17 years.8 This supplement, administered prior to COVID-19 vaccination and continued for 7 days post-vaccination, showed potential for alleviating vaccine hesitancy among parents and children.8

The impacts of COVID-19 on the dramatically increased use of digital tools in school education have also attracted considerable public attention, partly due to mitigation strategies such as school closures and restrictions, which have affected at least half of the global student population.9 Despite rapid advances in virtual learning technology and home-schooling platforms, the prolonged reliance on remote or distance learning in response to the COVID-19 pandemic poses profound risks to the cognitive and social development of adolescents. These risks arise from the absence of physical interactions with peers and teachers during the transition to adulthood.9 Such effects may be more pronounced in children and youth with behavioural or intellectual disabilities who rely on special education support services. In resource-constrained settings or among low-income families, effective education time is often substantially reduced due to inadequate access to electronic devices and limited internet connectivity, thereby exacerbating academic inequality. Addressing this challenge may require sustained government investment in community-based, targeted socio-technical interventions to close the social class achievement gaps and reduce the digital divide.10

Excessive screen time resulting from increased reliance on digital media has led to a range of public health concerns, including asthenopia and vision impairment. A clinical assessment of visual acuity among school-aged adolescents in western rural China revealed a significantly higher prevalence of asthenopia and worsened vision impairment during the COVID-19 pandemic compared with the pre-pandemic period.11 The striking progression of vision impairment highlights the urgent need for policymakers to develop system-level strategies and tailored guidelines aimed at promoting healthy screen time practices. Such measures are essential to address the increasing incidence of eye problems among students in the post—COVID-19 era, where digital media is deeply embedded in nearly every aspect of adolescents’ daily lives.

Coronavirus disease 2019 also posed multiple challenges throughout pregnancy because pregnant women infected with the virus faced a higher risk of severe illness relative to their non-pregnant counterparts.12 Additionally, they may experience exacerbation of COVID-19 symptoms due to reduced lung capacity associated with fetal growth and immune suppression during pregnancy.13 Although compelling evidence indicates that rigorous public health measures effectively mitigate the spread of SARS-CoV-2,14 pregnant women often exhibited high levels of anxiety about contracting COVID-19, largely due to their vulnerable immune status.15 This widespread anxiety may arise from perceived risks of pregnancy complications, fears of vertical transmission to the newborn, and uncertainties regarding delivery and breastfeeding practices in the event of infection.15 These observations highlight the importance of ensuring enhanced laboratory support for universal screening and providing adequate personal protective equipment. Emotional support is equally important. Satisfaction with maternity care can be achieved through partner companionship during labour.15 A multidisciplinary approach involving expert teams has proven essential in providing optimal care.12 However, changes to childbirth companionship and peripartum services during the COVID-19 pandemic frequently fell short of pregnant women’s expectations, potentially leading to negative psychological consequences such as heightened antenatal anxiety and emotional disturbance.16 Guidelines and decision-making in obstetric practice must balance infection control measures with the peripartum needs of women; the nulliparous group requires additional attention.

Older patients with COVID-19 are considered among the most vulnerable groups during the pandemic because advanced age and co-morbidities are well-documented risk factors for mortality.17 Clinical findings have supported frailty screening as a reliable predictor of clinical deterioration and adverse outcomes in older patients upon hospital admission.17 Furthermore, older adults were more likely to remain at home during the pandemic, with limited access to recreational activities or social support, while facing an increased risk of elder abuse.18 Tackling these issues may require government-led legislation and integrated social welfare services to reduce vulnerability to abuse and neglect among older adults, particularly those residing in long-term care facilities.19

A recent global review examined national plans and policies on maternal, newborn, child, and adolescent health services, as well as health services for older people across 110 countries.20 The findings revealed a significant knowledge gap, particularly regarding the absence of specific activities, monitoring indicators, or resource allocations aimed at mitigating potential service disruptions in the COVID-19 response and recovery plans. The insights gained from clinical management during this pandemic will undoubtedly inform the development of policy interventions and guide future interdisciplinary research to enhance preparedness for emerging and unforeseen public health challenges, ultimately improving health outcomes for vulnerable populations.

All authors had full access to the data, contributed to the study, approved the final version for publication, and take responsibility for its accuracy and integrity.

All authors have declared no conflict of interest.

This editorial received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

1. World Health Organization. Considerations for COVID-19 surveillance for vulnerable populations. Manila: World Health Organization; 2021.

2. World Health Organization. COVID-19 and the social determinants of health and health equity: evidence brief. Geneva: World Health Organization; 2021.

3. Irwin M, Lazarevic B, Soled D, Adesman A. The COVID-19 pandemic and its potential enduring impact on children. Curr Opin Pediatr 2022;34:107-15. Crossref

4. Wurm J, Ritz N, Zimmermann P. COVID-19 in children: evolving epidemiology, immunology, symptoms, diagnostics, treatment, post covid conditions, prevention strategies, and future directions. J Allergy Clin Immunol 2024 Nov 15. Epub ahead of print. Crossref

5. Leung KK, Ku SW, Fung RC, et al. Airway management in children with COVID-19. Hong Kong Med J 2022;28:315-20. Crossref

6. Wong JS, Wong TS, Chua GT, et al. COVID toe in an adolescent boy: a case report. Hong Kong Med J 2022;28:175-7. Crossref

7. Chua GT, Wong JS, Chung J, et al. Paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2: a case report. Hong Kong Med J 2022;28:76-8. Crossref

8. Chow CM, Cheong PK, Hu J, Ching JY. Can a microbiota-derived health supplement mitigate adverse events after COVID-19 vaccination in children? Hong Kong Med J 2023;29:542-4. Crossref

9. Leung KK, Hon KL, Ip P, Ng DK. COVID-19 and children: potential impacts and alleviation strategies. Hong Kong Med J 2023;29:443-7. Crossref

10. Golden AR, Srisarajivakul EN, Hasselle AJ, Pfund RA, Knox J. What was a gap is now a chasm: remote schooling, the digital divide, and educational inequities resulting from the COVID-19 pandemic. Curr Opin Psychol 2023;52:101632.Crossref

11. Ding Y, Guan H, Du K, Zhang Y, Wang Z, Shi Y. Asthenopia prevalence and vision impairment severity among students attending online classes in low-income areas of western China during the COVID-19 pandemic. Hong Kong Med J 2023;29:150-7. Crossref

12. Nana M, Hodson K, Lucas N, Camporota L, Knight M, Nelson-Piercy C. Diagnosis and management of COVID-19 in pregnancy. BMJ 2022;377:e069739. Crossref

13. Ahmed AK, Sijercic VC, Sayad R, et al. Risks and preventions for pregnant women and their preterm infants in a world with COVID-19: a narrative review. Vaccines (Basel) 2023;11:640. Crossref

14. Leung HH, Kwok CY, Sahota DS, et al. Effects of strict public health measures on seroprevalence of anti- SARS-CoV-2 antibodies during pregnancy. Hong Kong Med J 2022;28:294-9. Crossref

15. Lok WY, Chow CY, Kong CW, To WW. Knowledge, attitudes, and behaviours of pregnant women towards COVID-19: a cross-sectional survey. Hong Kong Med J 2022;28:124-32. Crossref

16. Hui PW, Seto MT, Cheung KW. Behavioural adaptations and responses to obstetric care among pregnant women during an early stage of the COVID-19 pandemic in Hong Kong: a cross-sectional survey. Hong Kong Med J 2022;28:367-75. Crossref

17. Tam EM, Kwan YK, Ng YY, Yam PW. Clinical course and mortality in older patients with COVID-19: a clusterbased study in Hong Kong. Hong Kong Med J 2022;28:215-22. Crossref

18. Shea YF, Ip WC, Luk JK. Comparison of the pattern of elderly abuse in Hong Kong before and after the COVID-19 pandemic. Hong Kong Med J 2022;28:502-3. Crossref

19. Gardner W, States D, Bagley N. The coronavirus and the risks to the elderly in long-term care. J Aging Soc Policy 2020;32:310-5. Crossref

20. Czerniewska A, Sharkey A, Portela A, Drapkin S, Mustafa S. National COVID-19 preparedness and response plans: a global review from the perspective of services for maternal, newborn, child and adolescent health and older people. BMJ Glob Health 2024;9:e013711. Crossref